Advocating for Universal Access to HCV Treatment in NV Corrections

Full Treatment
A former inmate pushed for Nevada Corrections to treat everyone with HCV
by Larry Buhl

With a federal class-action lawsuit filed in October, Nevada has become the latest state being sued for allegedly failing to properly treat inmates with chronic hepatitis C. The suit alleges that Nevada Department of Corrections inmates are not being provided the newest and most effective drugs used to treat and cure chronic hepatitis C (HCV), and names two inmates who claim prison doctors have allowed their conditions to worsen.

The lawsuit represents all Nevada inmates who have been or may be diagnosed with chronic hepatitis C. Similar lawsuits have been filed in states including Missouri, Colorado, Illinois, Kansas, Connecticut, Maine, Pennsylvania, Tennessee, and Florida.

HCV results in liver damage, cancer or death if untreated. According to the Centers for Disease Control and Prevention (CDC), newer antiretrovirals can cure 90 percent of people with chronic hepatitis C.

About 17 percent to 23 percent of inmates nationally are infected, while only about 1 percent of the general population is infected, according to the American Association for Liver Disease, which recommends testing inmates for the disease.

John Witherow, who has petitioned attorneys and Nevada prison officials to test inmates for HCV and provide treatments, is encouraged by the lawsuits in other states, he tells A&U. Witherow, president of Nevada’s Citizens United for the Rehabilitation of Errants, also called NV Cure, spent twenty-six years in Nevada prisons, and was released on parole about ten years ago. He said he was aware of the lack of hepatitis C treatment for his fellow inmates, though he was never infected.

“I saw a guy who was given interferon in prison and it didn’t do any good, and suffered for fifteen years with hep C,” Witherow said. “Prison doctors wait until a person reaches a certain level before they start treating them, and usually by that time they’re really sick.”

Hepatitis C is most commonly spread through sharing needles, according to the CDC. Getting tattoos and sharing razors, which is commonly done in prison, according to Witherow, can quickly spread the disease. Although he says some of the inmates came into prison with HCV.

“What we want is immediate and mandatory testing upon entering prison for everyone, just like they do for HIV,” Witherow said. “Right now unless they pay for it, they won’t get tested.”

Witherow’s journey started three years ago, when a law firm he approached failed to take any action for the inmates. Through NV Cure, he’s sent out newsletters to inmates every two months, and several readers came forward and agreed to file suit. One of the readers sent the newsletter to a Fresno-based lawyer, who agreed to take the case for two plaintiffs, one of whom is seriously ill, Witherow said.

Witherow added that he had been asking the Nevada legislature since 2003 to test every inmate and treat all who have the virus, but his calls fell on deaf ears.

Last year, facing a four-year class action lawsuit, the Pennsylvania Department of Corrections agreed to treat everyone infected with hepatitis C with the current “standard of medical care” of direct-acting antiviral drugs (DAAs), such as Harvoni or Sovaldi. Pennsylvania Corrections said it would start with the sickest inmates first and then cover everyone by 2022. That makes access to hepatitis C treatment in Pennsylvania prisons better than what Medicaid patients can obtain in some U.S. states.

The cost of Harvoni, one of thirteen FDA-approved treatments for hepatitis C, has dropped to about $13,000 a person for the simplest cases, making it increasingly difficult for state departments of correction to claim that treatment will break their budgets.

Speaking to A&U for the April 2019 Hep Talk column, Dr. Stacey Trooskin, director of the viral hepatitis program at Philadelphia FIGHT and professor at the University of Pennsylvania’s medical school, said the Pennsylvania corrections settlement is important for inmates and for public health.

“If we are going to eliminate hepatitis C as the health issue that it is, we must offer treatment for those living with the virus and for people who are at high risk of transmitting the virus. In this country drug use is criminalized, and for that reason, in prisons there is a disproportionate number of people with substance abuse disorder.”

State prisons often adopt their own guidelines, and many of them do not offer the most current and effective meds for those with hepatitis C. The CDC has estimated that one out of seven state prison inmates have the hepatitis C virus, but fewer than one percent of those patients are receiving adequate treatment.

Larry Buhl is a multimedia journalist, screenwriter, and novelist living in Los Angeles. Follow him on Twitter @LarryBuhl.